Bombardier C H, D'Amico C, Jordan J S
Department of Rehabilitation Medicine, University of Washington School of Medicine, Seattle.
Behav Res Ther. 1990;28(4):297-304. doi: 10.1016/0005-7967(90)90081-s.
There is evidence that adaptation to chronic illness may be affected by psychological factors, especially how patients appraise and cope with the stress of their illness. The purpose of the present study was to examine the relationship of stress appraisal and coping responses to multiple behavioral indices of illness adjustment among patients with diverse chronic medical conditions. One hundred and one patients admitted to a multidisciplinary medicine/psychiatry unit completed measures of functional impairment, depression, symptom severity, and the Ways of Coping Checklist--Revised. Hierarchical regression analyses indicated that emotion-focused coping was positively related to poor psychosocial adjustment and depression after controlling for physician rated disease severity. Appraising chronic illness as holding one back predicted greater emotion-focused coping responses and poorer adjustment to illness. The use of problem-focused coping strategies was generally unrelated to illness adjustment. These findings suggest the presence of an emotion-focused coping triad consisting of wishful thinking, self blame, and avoidance, all of which appear to be maladaptive strategies when coping with chronic medical conditions. Implications for coping skills training and the need for longitudinal research is discussed.
有证据表明，对慢性病的适应可能会受到心理因素的影响，尤其是患者如何评估和应对疾病带来的压力。本研究的目的是检验压力评估和应对反应与患有多种慢性疾病的患者疾病适应的多个行为指标之间的关系。入住多学科医学/精神病科病房的101名患者完成了功能损害、抑郁、症状严重程度以及修订后的应对方式清单的测量。分层回归分析表明，在控制医生评定的疾病严重程度后，以情绪为中心的应对方式与不良的心理社会适应和抑郁呈正相关。将慢性病视为阻碍自己的因素预示着更多以情绪为中心的应对反应和对疾病的较差适应。使用以问题为中心的应对策略通常与疾病适应无关。这些发现表明存在一个以情绪为中心的应对三联征，包括一厢情愿的想法、自责和回避，在应对慢性疾病时，所有这些似乎都是适应不良的策略。讨论了应对技能培训的意义以及纵向研究的必要性。
